Articulating endoscopic surgical clip applier

ABSTRACT

An apparatus for application of surgical clips to body tissue is provided and includes a handle assembly and a shaft assembly. The handle assembly includes a drive assembly; and a trigger operatively connected to the drive assembly. The shaft assembly extends from the handle assembly and includes an articulating neck assembly; and an end effector assembly supported on a distal end of the articulating neck assembly and being configured to form a surgical clip in place on the body tissue.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a Continuation application claiming thebenefit of and priority to U.S. patent application Ser. No. 14/486,306,filed Sep. 15, 2013, which is a Continuation application claiming thebenefit of and priority to U.S. patent application Ser. No. 13/772,998,filed Feb. 21, 2013, now U.S. Pat. No. 8,845,659, which is aContinuation application claiming the benefit of and priority to U.S.patent application Ser. No. 13/004,064, filed on Jan. 11, 2011, now U.S.Pat. No. 8,403,945, which claims the benefit of and priority to U.S.Provisional Application Ser. No. 61/308,093, filed on Feb. 25, 2010, thedisclosures of each of the above being hereby incorporated by referencein their entirety.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical clip appliers and, moreparticularly, to a novel articulating endoscopic surgical clip applier.

2. Background of Related Art

Endoscopic staplers and clip appliers are known in the art and are usedfor a number of distinct and useful surgical procedures. In the case ofa laparoscopic surgical procedure, access to the interior of an abdomenis achieved through narrow tubes or cannulas inserted through a smallentrance incision in the skin. Minimally invasive procedures performedelsewhere in the body are often generally referred to as endoscopicprocedures. Typically, a tube or cannula device is extended into thepatient's body through the entrance incision to provide an access port.The port allows the surgeon to insert a number of different surgicalinstruments therethrough using a trocar and for performing surgicalprocedures far removed from the incision.

During a majority of these procedures, the surgeon must often terminatethe flow of blood or another fluid through one or more vessels. Thesurgeon will often apply a surgical clip to a blood vessel or anotherduct to prevent the flow of body fluids therethrough during theprocedure. An endoscopic clip applier is known in the art for applying asingle clip during an entry to the body cavity. Such single clipappliers are typically fabricated from a biocompatible material and areusually compressed over a vessel. Once applied to the vessel, thecompressed clip terminates the flow of fluid therethrough.

Endoscopic clip appliers that are able to apply multiple clips inendoscopic or laparoscopic procedures during a single entry into thebody cavity are described in commonly-assigned U.S. Pat. Nos. 5,084,057and 5,100,420 to Green et al., which are both incorporated by referencein their entirety. Another multiple endoscopic clip applier is disclosedin commonly-assigned U.S. Pat. No. 5,607,436 to Pratt et al., thecontents of which is also hereby incorporated by reference herein in itsentirety. These devices are typically, though not necessarily, usedduring a single surgical procedure. U.S. patent application Ser. No.08/515,341 now U.S. Pat. No. 5,695,502 to Pier et al., the disclosure ofwhich is hereby incorporated by reference herein, discloses aresterilizable surgical clip applier. The clip applier advances andforms multiple clips during a single insertion into the body cavity.This resterilizable clip applier is configured to receive and cooperatewith an interchangeable clip magazine so as to advance and form multipleclips during a single entry into a body cavity. One significant designgoal is that the surgical clip be loaded between the jaws without anycompression of the clip from the loading procedure. Such bending ortorque of the clip during loading often has a number of unintendedconsequences. Such compression during loading may alter slightly thealignment of the clip between the jaws. This will cause the surgeon toremove the clip from between the jaws for discarding the clip.Additionally such preloading compression may slight compress parts ofthe clip and change a geometry of the clip. This will cause the surgeonto remove the compressed clip from between the jaws for discarding theclip.

Endoscopic or laparoscopic procedures are often performed remotely fromthe incision. Consequently, application of clips may be complicated by areduced field of view or reduced tactile feedback for the user at theproximal end of the device. It is therefore desirable to improve theoperation of the instrument by providing an instrument that is capableof articulating.

SUMMARY

The present disclosure relates to novel articulating endoscopic surgicalclip appliers.

BRIEF DESCRIPTION OF THE DRAWINGS

The present clip applier will be more fully appreciated as the samebecomes better understood from the following detailed description whenconsidered in connection with the following drawings, in which:

FIG. 1 is a front, perspective view of a surgical clip applier accordingto an embodiment of the present disclosure, shown in an articulatedcondition;

FIG. 2 is a rear, perspective view of the clip applier of FIG. 1, shownin an articulated condition;

FIG. 3 is a rear, left-side, perspective view of a handle assembly ofthe surgical clip applier of FIGS. 1 and 2, with a housing half-sectionremoved therefrom;

FIG. 4 is a front, right-side, perspective view of the handle assemblyof the surgical clip applier of FIGS. 1 and 2, with a housinghalf-section removed therefrom;

FIG. 5 is a perspective view, with parts separated, of the handleassembly of surgical the clip applier of FIGS. 1-4;

FIG. 6 is an enlarged perspective view of the indicated area of detailof FIG. 5;

FIG. 7 is an enlarged perspective view of the indicated area of detailof FIG. 5;

FIG. 8 is a front, perspective view of an articulation dial of thesurgical clip applier of FIGS. 1-4;

FIG. 9 is a perspective view, with parts separated, of an articulatingneck assembly of the surgical clip applier of FIGS. 1-4;

FIG. 10 is a front, perspective view of the handle assembly of thesurgical clip applier of FIGS. 1-4, with the housing removed therefrom,illustrating an articulation assembly in an un-actuated condition;

FIG. 11 is a longitudinal, cross-sectional view of the neck assembly ofFIG. 9, shown in an un-articulated condition;

FIG. 12 is a front, perspective view of the handle assembly of thesurgical clip applier of FIGS. 1-4, with the housing removed therefrom,illustrating the articulation assembly in an actuated condition;

FIG. 13 is a longitudinal, cross-sectional view of the neck assembly ofFIG. 9, shown in an articulated condition;

FIG. 14 is a front, perspective view of the surgical clip applier ofFIGS. 1-4, illustrating a rotation of the shaft assembly thereof;

FIG. 15 is a cross-sectional view as taken through 15-15 of FIG. 14;

FIG. 16 is a perspective view, with parts separated, of a clip applyingend effector assembly of the clip applier of FIGS. 1-4;

FIG. 17 is a perspective view of the clip applier end effector assemblyof FIG. 16, with an outer tube removed therefrom;

FIG. 18 is a perspective view of the clip applier end effector assemblyof FIG. 16, with the outer tube and a pusher bar removed therefrom;

FIG. 19 is a perspective view of the clip applier end effector assemblyof FIG. 16, with the outer tube, the pusher bar and an upper housingremoved therefrom;

FIG. 20 is a perspective view of the clip applier end effector assemblyof FIG. 16, with the outer tube, the pusher bar, the upper housing andan advancer plate removed therefrom;

FIG. 21 is a perspective view of the clip applier end effector assemblyof FIG. 16, with the outer tube, the pusher bar, the upper housing, theadvancer plate and a clip carrying channel removed therefrom;

FIG. 22 is a perspective view of the clip applier end effector assemblyof FIG. 16, with the outer tube, the pusher bar, the upper housing, theadvancer plate, the clip carrying channel and the jaws removedtherefrom;

FIG. 23 is a distal, top, perspective view of the clip applier endeffector assembly of FIG. 17;

FIG. 24 is an enlarged view of the indicated area of detail of FIG. 23;

FIG. 25 is a distal, bottom, perspective view of the clip applier endeffector assembly of FIG. 17;

FIG. 26 is an enlarged view of the indicated area of detail of FIG. 25;

FIG. 27 is a longitudinal, side-elevational, cross-sectional view of theclip applier of FIGS. 1-4;

FIG. 28 is an enlarged view of the indicated area of detail of FIG. 27;

FIG. 29 is an enlarged view of the indicated area of detail of FIG. 28;

FIG. 30 is a cross-sectional view as taken through 30-30 of FIG. 29;

FIG. 31 is a cross-sectional view as taken through 31-31 of FIG. 29;

FIG. 32 is a cross-sectional view as taken through 32-32 of FIG. 29;

FIG. 33 is a cross-sectional view as taken through 33-33 of FIG. 28;

FIG. 34 is a cross-sectional view as taken through 34-34 of FIG. 28;

FIG. 35 is an enlarged view of the indicated area of detail of FIG. 27;

FIG. 36 is an enlarged view of the indicated area of detail of FIG. 35;

FIG. 37 is an enlarged view of the indicated area of detail of FIG. 35;

FIG. 38 is a top, perspective view of a clip follower according to thepresent disclosure;

FIG. 39 is a bottom, perspective view of a clip follower according tothe present disclosure;

FIG. 40 is a cross-sectional view as taken through 40-40 of FIG. 38;

FIG. 41 is a top, perspective view of the clip channel, advancer plate,clip follower and stack of clips, shown in an assembled condition;

FIG. 42 is a bottom, perspective view of the clip channel, advancerplate, clip follower and stack of clips, shown in an assembledcondition;

FIG. 43 is an enlarged view of the indicated area of detail of FIG. 41;

FIG. 44 is an enlarged view of the indicated area of detail of FIG. 42;

FIG. 45 is a cross-sectional view as taken through 45-45 of FIG. 41;

FIG. 46 is an enlarged view of the indicated area of detail of FIG. 45;

FIG. 47 is a right side, elevational view of the internal components ofthe handle assembly, illustrating an initial actuation of the trigger ofthe surgical clip applier;

FIG. 48 is a cross-sectional view as taken through 48-48 of FIG. 47;

FIG. 49 is a top, perspective view of the end effector assembly of thesurgical clip applier, with the outer tube removed, during the initialactuation of the trigger of the surgical clip applier;

FIG. 50 is a bottom, perspective view of the end effector assembly ofthe surgical clip applier, with the outer tube removed, during theinitial actuation of the trigger of the surgical clip applier;

FIG. 51 is a cross-sectional view as taken through 51-51 of FIG. 49;

FIG. 52 is an enlarged view of the indicated area of detail of FIG. 51;

FIG. 53 is an enlarged view of the indicated area of detail of FIG. 51;

FIG. 54 is an enlarged, cross-sectional view of the area indicated as 52in FIG. 51, illustrating a further actuation of the trigger of thesurgical clip applier;

FIG. 55 is an enlarged view of the indicated area of detail of FIG. 54;

FIG. 56 is a longitudinal, cross-sectional view of the clip follower asillustrated in FIG. 55;

FIG. 57 is a top, perspective view of the end effector assembly of thesurgical clip applier, with the outer tube removed, during the furtheractuation of the trigger of the surgical clip applier;

FIG. 58 is a bottom, perspective view of the end effector assembly ofthe surgical clip applier, with the outer tube removed, during thefurther actuation of the trigger of the surgical clip applier;

FIG. 59 is an enlarged, cross-sectional view of the area indicated as 35in FIG. 27, illustrating the further actuation of the trigger of thesurgical clip applier;

FIG. 60 is an enlarged view of the indicated area of detail of FIG. 59;

FIG. 61 is an enlarged view of the indicated area of detail of FIG. 59;

FIG. 62 is an enlarged view of the indicated area of detail of FIG. 61;

FIG. 63 is an enlarged, cross-sectional view of the area indicated as 28in FIG. 27, illustrating a complete actuation of the trigger of thesurgical clip applier;

FIG. 64 is a cross-sectional view of as taken through 64-64 of FIG. 63;

FIG. 65 is an enlarged, top, perspective view of a proximal end of theend effector assembly at the full actuation of the trigger;

FIG. 66 is a bottom, front perspective view of a distal end of the endeffector assembly, illustrating a closure of the jaws at the fullactuation of the trigger;

FIG. 67 is a cross-sectional view as taken through 67-67 of FIG. 66;

FIG. 68 is a perspective view, illustrating a surgical clip in place ona vessel;

FIG. 69 is an enlarged, cross-sectional view of the area illustrated inFIG. 34, illustrating a re-setting of the trigger of the surgical clipapplier; and

FIG. 70 in an enlarged, cross-sectional view of the area illustrated inFIG. 27, illustrating the re-setting of the trigger of the surgical clipapplier.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of surgical clip appliers in accordance with the presentdisclosure will now be described in detail with reference to the drawingfigures wherein like reference numerals identify similar or identicalstructural elements. As shown in the drawings and described throughoutthe following description, as is traditional when referring to relativepositioning on a surgical instrument, the term “proximal” refers to theend of the apparatus which is closer to the user and the term “distal”refers to the end of the apparatus which is further away from the user.

Referring now to FIGS. 1-25, a surgical clip applier in accordance withan embodiment of the present disclosure is generally designated as 100.Clip applier 100 includes a handle assembly 200 and an articulatingendoscopic portion including a shaft assembly 300 extending distallyfrom handle assembly 200.

Referring now to FIGS. 1-8, handle assembly 200 of surgical clip applier100 is shown. Handle assembly 200 includes a housing 202 having a firstor right side half-section 202 a and a second or left side half-section202 b. Handle assembly 200 includes a trigger 208 pivotably supportedbetween right side half-section 202 a and left side half-section 202 b.Trigger 208 is biased to an un-actuated position by a biasing member210, in the form of a spring or the like. Housing 202 of handle assembly200 may be formed of a suitable plastic material.

As seen in FIGS. 3-4, housing 202 supports a drive assembly 220 betweenright side half-section 202 a and left side half-section 202 b. Driveassembly 220 includes a drive block 222 translatably, slidably supportedbetween right side half-section 202 a and left side half-section 202 bof housing 202, for movement thereof along a longitudinal axis “X” ofclip applier 100. Drive block 222 includes nubs 222 a projecting fromopposed lateral sides thereof for pivotably and slidably connection inelongated channels 208 a formed in trigger 208. Drive block 222 definesa threaded or helical lumen 222 b therethrough

As seen in FIGS. 3-6, handle assembly 200 further includes a ratchetmechanism 230 disposed in housing 202. Ratchet mechanism 230 includes atoothed-rack 232 defined or supported in housing 202, and a pawl 234pivotally supported on drive block 222 at a location wherein pawl 234 isin substantial operative engagement with toothed-rack 232.

Pawl 234 includes a pawl tooth 234 a which is selectively engageablewith the teeth of rack 232. Pawl tooth 234 a is engageable with theteeth of rack 323 to restrict longitudinal movement of drive block 222and, in turn, trigger 208. A pawl spring 236 is provided to bias pawl234 into operative engagement with the teeth of rack 232.

Toothed-rack 232 includes a plurality of teeth 232 a interposed betweena distal reversing recess 232 b and a proximal reversing recess 232 c.In use, with pawl in either distal reversing recess 232 b or proximalreversing recess 232 c, as drive block 222, and thus pawl 234, istranslated in a first direction relative to tooth-rack 232, tooth 234 ais pulled across the teeth 232 a of toothed-rack 232. The translation ofdrive block 222 can not be reversed until tooth 234 a of pawl 234reaches the other of either distal reversing recess 232 b or proximalreversing recess 232 c of toothed-rack 232, such that an orientation ofpawl 234 may be re-set or reversed. Once the orientation of pawl 234 iseither re-set or reversed, drive block 222 may be translated in anopposite direction. As so constructed, it is apparent that the directionof translation of drive block 222 can not be reversed until a completestoke or travel length of drive block 222 is accomplished.

With continued reference to FIGS. 3-6, drive assembly 220 furtherincludes a drive screw 224 rotatably supported within housing 202. Drivescrew 224 includes a proximal tip 224 a for establishing a point contactwithin a cup 202 c (see FIG. 28) provided in housing 202. Drive screw224 further includes an outer helical thread 224 b extending along alength thereof and configured to mate within helical lumen 222 b ofdrive block 222. Drive screw 224 further includes a crown of teeth 224 csupported at a distal end thereof. In use, as trigger 208 is actuatedtrigger 208 translates drive block 222 through housing 202. As driveblock 222 is translated through housing 202, helical lumen 222 b ofdrive block 222 cooperates with helical thread 224 b of drive screw 224to result in rotation of drive screw 224.

Drive assembly 220 further includes a clutch gear 226 rotatablysupported in housing 202 and keyed to drive shaft 250 (see FIGS. 16 and31). Clutch gear 226 defines a crown of gear teeth 226 a configured anddimensioned to cooperate and selectively engage the crown of teeth 224 cof drive screw 224. Clutch gear 226 may be biased, by a biasing member228, such that crown of teeth 226 a thereof is in engagement with thecrown of teeth 224 c of drive screw 224. Clutch gear 226 defines anouter annular race 226 d therein.

Drive assembly 220 further includes a clutch bracket 238 pivotallysupported in housing 202. Clutch bracket 238 includes a pair of legs 238a extending around clutch gear 226, and a boss 238 b, extending fromeach leg 238 a and into annular race 226 d of clutch gear 226. A freeend 238 c of each leg 238 a extends an amount sufficient to engage a rib208 b formed on trigger 208. In use, as clutch bracket 238 is pivoteddistally (due to biasing member 228) and proximally, due to thesqueezing and releasing of trigger 208, clutch bracket 238 approximatesand separates clutch gear 226 with the crown of teeth 224 c of drivescrew 224.

With reference to FIGS. 1-7, handle assembly 200 of clip applier 100further includes a rotation assembly 240 having a rotation knob 242rotatably supported on and in housing 202 at a distal end thereof. Knob242 includes grip portion 242 a disposed externally of housing 202 and astem portion 242 b disposed within housing 202. Knob 242 defines a lumen242 c therethrough. Stem portion 242 b defines a pair of opposed,longitudinally extending channels or grooves 242 b ₁, 242 b ₂ formed inthe wall of lumen 242 c.

As seen in FIGS. 1-15, handle assembly 200 also includes an articulationassembly 260 supported on or in housing 202. Articulation assembly 260includes an articulation dial 262 rotatably supported in and projectingfrom housing 202. Articulation dial 262 is secured to or keyed to atubular screw body 266 of articulation assembly 260. As seen in FIG. 7,articulation dial 262 includes at least one rib 262 a formed on a facethereof for operative engagement with teeth 264 a of a ratchet gear 264.Toothed-gear 264 functions to increase the friction for rotation of dial262 thereby helping to maintain the position of rotation dial 264, and,in turn, the articulation of the end effector, once the user hasselected a desired orientation or articulation of the end effectorassembly. Additionally, toothed-gear 264 provides the user with a degreeof audible/tactile feedback.

Articulation assembly 260 further includes a tubular screw body 266rotatably supported in lumen 242 c of stem portion 242 b of knob 242.Tubular screw body 266 defines a central lumen 266 a, through whichdrive shaft 250 extends, and a pair of oppositely extending helicalgrooves 266 b, 266 c formed in an outer surface thereof.

Articulation assembly 260 further includes a pair of opposedarticulation cuffs 268, 270 translatably interposed between stem portion242 b of knob 242 and tubular screw body 266. Each cuff 268, 270includes a respective rail 268 a, 270 a formed on an outer surfacethereof and configured for slidably receipt in a respective on of thepair of opposed, longitudinally extending channels 242 b ₁, 242 b ₂formed in the wall of lumen 242 c. Each cuff 268, 270 further includes arespective thread portion 268 b, 270 b formed on an inner surfacethereof and configured for slidably receipt in a respective on of thepair of oppositely extending helical grooves 266 b, 266 c formed in theouter surface of the tubular screw body 266. Each cuff 268, 270 issecured to a proximal end of a respective articulation cable 252, 254.

In use, as seen in FIGS. 10-14, as articulation dial 262 is rotated in afirst direction, tubular screw body 266 is also rotated in the firstdirection. As tubular screw body 266 is rotated in the first direction,cuffs 268, 270 are caused to be translated in opposed axial directionsrelative to one another. As cuffs 268, 270 are caused to be translatedin opposed axial directions relative to one another, so too are therespective articulation cables 252, 254 translated in opposed axialdirections relative to one another. As the respective articulationcables 252, 254 are translated in opposed axial directions relative toone another, the end effector assembly is caused to be articulatedoff-axis. The greater the degree of rotation of articulation dial 262,the greater the degree of articulation of the end effector assembly. Inorder to articulate the end effector in the opposite direction, the useronly needs to rotate the articulation dial 262 in an opposite direction.

Turning now to FIGS. 1-5 and 9-26, shaft assembly 300 of clip applier100 is shown and will be described. Shaft assembly 300 and thecomponents thereof may be formed of suitable biocompatible materials,such as, for example, stainless steel, titanium, plastics and the like.

Shaft assembly 300 includes an outer tube 302 having a proximal end 302a supported within housing 202, a distal end 302 b, and a lumen 302 cextending therethrough. Outer tube 302 is secured to rotation knob 242of rotation assembly 240 by way of nubs 242 d (see FIGS. 7, 15 and 30)of knob 242 extending from lumen 242 c thereof and into respectiveopenings 302 d formed near proximal end 302 a of outer tube 302. In use,as seen in FIGS. 14 and 15, as knob 242 is rotated, the rotation thereofis transmitted to outer tube 302 by nubs 242 d of knob 242, therebyrotating shaft assembly 300 about the longitudinal “X” axis.

As seen in FIGS. 1, 2 and 9-14, shaft assembly 300 includes anarticulating neck assembly 310 supported at distal end 302 b of outertube 302. Articulating neck assembly 310 permits a distal end of shaftassembly 302 to be articulated off-axis relative to the longitudinal “X”axis of clip applier 100 and of shaft assembly 300.

Articulating neck assembly 310 includes a proximal articulation joint312 supported at and/or connected to distal end 302 b of proximal outertube 302, a plurality of inter-connected articulation joints 314supported at and/or connected to proximal articulation joint 312, and adistal articulation joint 316 supported at and/or connected to a distalend of inter-connected articulation joints 314. Articulation cables (notshown) extend from cuffs 268, 270 of articulation assembly 260, throughproximal outer tube 302, through proximal articulation joint 312,through inter-connected articulation joints 314, and are fixedly securedto distal articulation joint 316. In this manner, as articulation dial262 is rotated, as described above, the articulation cables aretranslated, and thus, the neck assembly 310 is articulated.

As seen in FIGS. 16-26, shaft assembly 300 further includes an endeffector assembly 320 supported at and/or connected to distalarticulation joint 316 of neck assembly 310. End effector assembly 320includes an outer tube 322 having a proximal end 322 a connected todistal articulation joint 316, a distal end 322 b, and a lumen 322 cextending therethrough.

End effector assembly 320 further includes an upper housing 324 and alower housing 326, each disposed within lumen 322 c of outer tube 322.As seen in FIG. 16, upper housing 324 defines a window 324 a formed neara distal end thereof, a longitudinally extending slot 324 b formedproximal of window 324 a, and a nub 324 c projecting from an uppersurface of upper housing 324 and located proximal of slot 324 b.

As seen in FIGS. 16 and 18, end effector assembly 320 further includes apusher bar 330 slidably disposed between outer tube 322 and upperhousing 324. Pusher bar 330 includes a distal end 330 a defining apusher 330 c configured and adapted to selectively engage/move (i.e.,distally advance) a distal-most clip “C1” of a stack of clips “C” and toremain in contact with the distal-most clip “C1” during an initialformation thereof. Pusher bar 330 defines a distal slot 330 d configuredto slidably receive a tab 322 b of an advancer plate 322, a proximalslot 330 e located proximal of distal slot 330 d and configured toslidably receive nub 324 c of upper housing 324, and spring or snap clip330 f extending proximally from a proximal end 330 b thereof. Snap clip330 f is configured in such a manner that the tines thereof selectivelyengage a nub 344 d projecting from drive sled 344.

As seen in FIGS. 16 and 19, end effector assembly 320 further includesan advancer plate 332 reciprocally supported beneath upper housing 324.Advancer plate 332 includes a series of windows 332 a formed therein andextending along a length thereof. As seen in FIGS. 41 and 43, eachwindow 332 a defines a proximal edge that extends below a surface ofadvancer plate 332 so as to define a lip or ledge 332 c. Advancer plate332 further includes a tab or fin 332 b extending or projecting from anupper surface thereof, in a direction toward upper housing 324. As seenin FIG. 18, tab 332 b slidably extends through slot 324 b of upperhousing 324 and through distal slot 330 d of pusher 330.

As seen in FIGS. 16 and 20, end effector assembly 320 further includes aclip carrier 334 disposed beneath advancer plate 332 and beneath upperhousing 324. Clip carrier 334 is generally a box-like structure havingan upper wall, a pair of side walls and a lower wall defining a channeltherethrough. Clip carrier 334 includes a plurality of spaced apartwindows 334 a (see FIGS. 42 and 44) formed in the lower wall andextending longitudinally along a length thereof. Clip carrier 334includes an elongate channel or window formed in the upper wall andextending longitudinally along a length thereof.

As seen in FIGS. 16 and 20, a stack of surgical clips “C” is loadedand/or retained within the channel of clip carrier 334 in a manner so asto slide therewithin and/or therealong. The channel of clip carrier 334is configured and dimensioned to slidably retain the stack or pluralityof surgical clips “C” in tip-to-tail fashion therewithin.

A distal end portion of clip carrier 334 includes a pair of spacedapart, resilient tangs 334 b. Tangs 334 b are configured and adapted todetachably engage a backspan of a distal-most surgical clip “C1” of thestack of surgical clips “C” retained within clip carrier 334.

As seen in FIGS. 16, 20 and 38-40, end effector assembly 320 of clipapplier 100 further includes a clip follower 336 slidably disposedwithin the channel of clip carrier 334. As will be described in greaterdetail below, clip follower 336 is positioned behind the stack ofsurgical clips “C” and is provided to urge the stack of clips “C”forward during an actuation of clip applier 100. As will be described ingreater detail below, clip follower 336 is actuated by the reciprocatingforward and backward motion of advancer plate 332.

As seen in FIGS. 38-40, clip follower 336 includes an upper tab 336 aextending substantially upwardly and rearwardly from clip follower 336,and a lower tab 336 b extending substantially downwardly and rearwardlyfrom clip follower 336.

Upper tab 336 a of clip follower 336 is configured and dimensioned toselectively engage ledges 332 c of windows 332 a of advancer plate 332.In use, engagement of upper tab 336 a of clip follower 336 againstledges 332 c of windows 332 a of advancer plate 332 causes clip follower336 to incrementally advance or travel distally as advancer plate 332 isadvanced or moved in a distal direction.

Lower tab 336 b is configured and dimensioned to selectively engagewindows 334 a formed in clip carrier 334. In use, engagement of lowertab 336 b of clip follower 336 in a window 334 a formed clip carrier 334prevents clip follower 336 from traveling or moving in a proximaldirection.

As seen in FIGS. 16-21, end effector assembly 320 of surgical clipapplier 100 includes a pair of jaws 326 mounted at a distal end of upperhousing 324 and outer tube 322 and actuatable by trigger 208 of handleassembly 200. Jaws 326 are formed of a suitable biocompatible materialsuch as, for example, stainless steel or titanium and define a channel326 a therebetween for receipt of a surgical clip “C” therein. When jaws326 are in an open or un-approximated condition relative to each other,a width of jaws 326 measures greater than an outer diameter of shaftassembly 300. Jaws 326 are mounted in the distal end of upper housing324 and outer tube 322 such that they are longitudinally stationaryrelative thereto.

As seen in FIGS. 25 and 26, each jaw 326 includes a respective raisedcamming surface 326 b projecting from a lower surface thereof. Cammingsurfaces 326 b of jaws 326 permit another driving camming memberselective, inter-locking engagement therewith, for closing andcompressing of jaws 326.

As seen in FIGS. 16 and 22, end effector assembly 320 includes a driverbar 340 slidably interposed between jaws 326 and outer tube 322. Drivebar 340 defines a pair of driver camming surfaces 340 a formed near adistal end thereof and being configured for selective inter-lockingengagement with camming surfaces 326 b of jaws 326.

End effector assembly 320 further includes a slider joint 342 connectedto and extending proximally from a proximal end of drive bar 340. Sliderjoint 342 includes a nub 342 a projecting from a surface thereof in adirection of jaws 326. Slider joint 342 includes a stem 342 b extendingproximally therefrom and a tab 342 c projecting from a proximal end ofstem 342 b, in a direction away from upper housing 324.

End effector assembly 320 further includes a drive sled 344 slidablydisposed within outer tube 322. Drive sled 344 includes a drive block344 a disposed proximally of upper housing 324 and defining a helicallumen 344 b extending therethrough. Drive sled 344 further includes adrive channel 344 c extending distally from drive block 344 a, andextending between jaws 326 and outer tube 322. Drive channel 344 c isconfigured to slidably receive tab 342 c of slider joint 342 therein.Drive block 344 a includes a nub 344 d projecting from an upper surfacethereof and being configured for selective engagement by snap clip 330 fof pusher bar 330.

End effector assembly 320 further includes a helical drive screw 346rotatably supported on upper housing 324, and extending proximallytherefrom. Helical drive screw 346 is operatively connected to and/orreceived in helical lumen 344 b of drive sled 344. A proximal end ofhelical drive screw 346 is connected to a distal end of a drive cable256 (see FIG. 9) that is in turn connected to a distal end of driveshaft 250.

In use, as will be described in greater detail below, as helical drivescrew 346 is rotated in a first direction, due to the rotation of driveshaft 250 and drive cable 256, helical drive screw 346 interacts withhelical lumen 344 b of drive sled 344 to axially advance drive sled 344,and vice-versa.

Additionally, as drive sled 344 is advanced in a distal direction, drivesled 344 pushes pusher bar 330 and is advanced distally due to theconnection of snap clip 330 f of pusher bar 330 with nub 344 d of drivesled 344. As pusher bar 330 is advanced distally, pusher 330 c thereofcontacts a backspan of a distal-most clip “C1” and advances thedistal-most clip “C1” in a distal direction to load the clip betweenjaws 326.

Also, as pusher bar 330 is advanced distally, distal slot 330 d thereofis advanced distally relative to tab 332 b of advancer plate 332. Whentab 332 b of advancer plate 332 has traversed a length of distal slot330 d, a proximal end of slot 330 d abuts against tab 332 b and beginsto urge advancer plate 332 distally.

Concomitantly with the advancement of pusher bar 330, drive channel 334c of drive sled 344 is distally advanced and translated relative to stem342 b of slider joint 342. Drive channel 344 c of drive sled 344 isadvanced distally until a shoulder 344 e thereof engages a shoulder 340b of drive bar 340. Drive sled 344 is configured and dimensioned suchthat drive sled 344 does not engage drive bar 340 until after pusher bar330 has advanced distal-most clip “C1” into jaws 326. When shoulder 344e of drive sled 344 engages shoulder 340 b of drive bar 340, drive sled344 advances drive bar 340 in a distal direction.

Pusher bar 330 is advanced distally until proximal slot 330 e thereofengages nub 324 c of upper housing 324. At this point, distaladvancement of pusher bar 330 is stopped. However, as helical drivescrew 346 continues to rotate and advance drive sled 344 in a distaldirection, nub 344 d of drive sled 344 disengages from snap clip 330 fof pusher bar 330 to thereby allow further distal advancement of drivesled 344.

As drive sled 344 is further advanced distally, after engagement withdrive bar 340, drive bar 340 is advanced distally to thereby close jaws326 and to form the clip “C” disposed therewithin.

As seen in FIGS. 16-26, when end effector assembly 320 is in anun-actuated condition, drive block 344 a of drive sled 344 is located ata proximal end of helical drive screw 346.

Turning now to FIGS. 27-70, the operation of surgical clip applier 100,to form or crimp a surgical clip “C” around a target tissue, such as,for example, a vessel “V,” will now be described. With reference toFIGS. 27-46, surgical clip applier 100 is shown prior to any operationor use thereof. As seen in FIG. 27-34, prior to use or firing of clipapplier 100, trigger 208 is generally in an uncompressed or un-actuatedstate.

When trigger 208 is in the un-actuated position, drive block 222 is at adistal-most position on drive screw 224 of handle assembly 200. As such,pawl 234 is disposed within or is in registration with distal reversingrecess 232 b of toothed-rack 232.

With trigger 208 in the un-actuated position, as seen in FIG. 29, rib208 b of trigger 208 contacts free end 238 c of clutch bracket 238 andurges clutch bracket 238 in a distal direction to thereby maintainclutch gear 226 separate from the crown of teeth of 224 c of drive screw224.

As seen in FIGS. 35-46, with trigger 208 in the un-actuated position,pusher bar 330 is at a proximal-most position such that pusher 303 cthereof is disposed proximally of the backspan of a distal-most clip“C1” of the stack of clips. Also, drive sled 344 is disposed at aproximal-most position on drive screw 346 of end effector assembly 320.

Turning now to FIGS. 47 and 48, during an initial actuation or firing oftrigger 208, trigger 208 acts on drive block 222 to urge drive block 222in a proximal direction. As drive block 222 is moved in the proximaldirection, drive block 222 acts on drive screw 224 of handle assembly200 to cause drive screw 224 to rotate. Additionally, as drive block 222is moved in the proximal direction, pawl 234 is moved from distalreversing recess 232 b of toothed-rack 232 to the teeth 232 a oftoothed-rack 232. In this manner, trigger 208 can not return to anun-actuated position until a complete stroke thereof is achieved.

As trigger 208 is initially actuated, rib 208 b of trigger 208 is movedfrom contact with free end 238 c of clutch bracket 238 allowing biasingmember 228 to urge clutch gear 226 into operative engagement with thecrown of teeth of 224 c of drive screw 224 and thus cause clutch bracket238 to pivot. With clutch gear 226 into operative engagement with thecrown of teeth of 224 c of drive screw 224, rotation of drive screw 224of handle assembly 200 results in rotation of drive shaft 250, and inturn drive screw 346 of end effector assembly 320.

As seen in FIGS. 49-53, during the initial actuation of trigger 208, asdrive screw 346 of end effector assembly 320 is rotated, drive screw 346interacts with helical lumen 344 b of drive sled 344 to axially advancedrive sled 344. As drive sled 344 is advanced in a distal direction,drive sled 344 pushes pusher bar 330 and is advanced distally due to theconnection of snap clip 330 f of pusher bar 330 with nub 344 d of drivesled 344. As pusher bar 330 is advanced distally, pusher 330 c thereofcontacts a backspan of a distal-most clip “C1” and advances thedistal-most clip “C1” in a distal direction to move distal-most clip“C1” beyond tangs 334 b of clip carrier 334 and to load the distal-mostclip “C1” between jaws 326.

During the initial actuation of trigger 208, pusher bar 330 is advanceddistally until distal slot 330 d thereof is advanced into contact withtab 332 b of advancer plate 332. Also during the initial actuation oftrigger 208, as seen in FIGS. 50 and 52, drive channel 344 c of drivesled 344 is spaced from drive bar 340 and shoulder 344 e thereof has notyet contacted drive bar 340.

Turning now to FIGS. 54-58, during a further actuation or firing oftrigger 208, drive screw 224 of handle assembly 200 is continued torotate, resulting in continued rotation of drive shaft 250, and in turndrive screw 346 of end effector assembly 320.

During the further rotation of drive screw 346 of end effector assembly320, drive sled 344 is continued to be axially advanced. At this stage,as drive sled 344 is advanced in a distal direction, drive sled 344continues to push pusher bar 330 distally which, in turn, pushes on tab332 b of advancer plate 332 to begin distally advancing advancer plate332. As advancer plate 332 is advanced distally, lip 332 c of advancerplate 332 engages upper tab 336 a of clip follower 336 to advance clipfollower 336 in a distal direction, and in turn the remaining stack ofclips “C.” Also, as advancer plate 332 is advanced distally, lower tab336 b thereof is pulled from a proximal window 334 a of clip follower334 and moved to an adjacent window 334 a of clip follower 334.

As pusher bar 330 is further advanced distally, pusher 330 c thereofcontinues to advance the distal-most clip “C1” into jaws 326. During thefurther actuation of trigger 208, pusher bar 330 is advanced distallyuntil proximal slot 330 e thereof is advanced into contact with nub 324b of upper housing 324.

Turning now to FIGS. 59-68, during a final actuation or firing oftrigger 208, drive screw 224 of handle assembly 200 is continued torotate, resulting in continued rotation of drive shaft 250, and in turndrive screw 346 of end effector assembly 320.

During the final rotation of drive screw 346 of end effector assembly320, drive sled 344 is continued to be axially advanced. At this stage,as drive sled 344 is advanced in a distal direction, since pusher bar330 is blocked from distal advancement by nub 324 b of upper housing324, nub 344 b of drive sled 344 is disengaged from the tines of snapclip 330 f of pusher bar 330 to thereby allow further distal advancementof drive sled 344.

Additionally, during the final rotation of drive screw 346 of endeffector assembly 320, shoulder 344 e of drive channel 344 c of drivesled 344 is brought into contact with drive bar 340 and urges drive bar340 in a distal direction. As drive bar 340 is urged in the distaldirection, driver camming surfaces 340 a engage camming surfaces 326 bof jaws 326 to urge jaws 326 to close and form clip “C1,” disposedtherebetween, on a vessel “V” or the like (see FIG. 68).

Concomitantly therewith, as seen in FIGS. 63 and 64, as trigger 208 isfully actuated, drive block 222 is moved to a proximal-most positionsuch that pawl 234 is moved into proximal reversing recess 232 a oftoothed-rack 232 wherein pawl 234 resets itself. In this manner, trigger208 is free to return to the un-actuated position.

Turning now to FIGS. 69 and 70, following a complete actuation oftrigger 208 and a resetting of pawl 234, trigger 208 is released toallow trigger 208 to return to the un-actuated position due to theaction of the biasing member 210 (see FIGS. 3-5). As trigger 208 isreturned to the un-actuated position, trigger 208 acts on drive block222 to urge drive block 222 in a distal direction. As drive block 222 ismoved in the distal direction, drive block 222 acts on drive screw 224of handle assembly 200 to cause drive screw 224 to rotate in an oppositedirection. Additionally, as drive block 222 is moved in the distaldirection, pawl 234 is moved from proximal reversing recess 232 a oftoothed-rack 232 ultimately to distal reversing recess 232 b oftoothed-rack 232.

As trigger 208 is returned to the un-actuated position, rib 208 b oftrigger 208 contacts free end 238 c of clutch bracket 238 and urgesclutch bracket 238 to disengage clutch gear 226 from the crown of teethof 224 c of drive screw 224, and to re-bias biasing member 228.

As trigger 208 is returned to the un-actuated position and drive screw224 is rotated, drive screw 224 of handle assembly 200 reverses therotation of drive shaft 250, and in turn drive screw 346 of end effectorassembly 320. As drive screw 346 is rotated in an opposite directionfollowing a complete actuation, drive screw 346 acts on drive sled 344to move drive sled 344 in a proximal direction.

As drive sled 344 is moved in a proximal direction, nub 344 b of drivesled 344 acts on or is re-captured by the tines of snap clip 330 f ofpusher bar 330 and thus pulls pusher bar 330 in a proximal direction. Aspusher bar 330 is moved in a proximal direction, when a distal end ofdistal slot 330 d thereof engages tab 332 b of advancer plate 332,pusher bar 330 urges advancer plate 332 in a proximal direction untiltab 332 b thereof reaches a proximal end of slot 324 b formed in upperhousing 334. As pusher bar 330 is pulled in a proximal direction, pusher330 c thereof is caused to be moved proximal of the new distal-most clip“C1.”

Additionally, as drive sled 344 is moved in a proximal direction, drivesled 334 engages tab 342 c (see FIG. 16) of stem 342 b of slider joint342 to thereby pull slider joint 334 and, in turn, drive bar 340 in aproximal direction. As drive bar 340 is moved in the proximal direction,jaws 326 are allowed to re-open due to their own spring-likecharacteristics.

As can be appreciated, the firing sequence may be repeated as many timesas desired or necessary, or until all of the clips have been fired.

It should be understood that the foregoing description is onlyillustrative of the present disclosure. Various alternatives andmodifications can be devised by those skilled in the art withoutdeparting from the disclosure. Accordingly, the present disclosure isintended to embrace all such alternatives, modifications and variances.The embodiments described with reference to the attached drawing figuresare presented only to demonstrate certain examples of the disclosure.Other elements, steps, methods and techniques that are insubstantiallydifferent from those described above and/or in the appended claims arealso intended to be within the scope of the disclosure.

What is claimed is:
 1. An apparatus for application of surgical clips tobody tissue, the apparatus comprising: a housing; a drive assemblysupported in the housing, the drive assembly including: a drive screwrotatably supported in the housing, the drive screw supporting a crownof teeth; a clutch gear rotatably supported in the housing, the clutchgear defining a crown of gear teeth configured to cooperate andselectively engage the crown of teeth of the drive screw; a clutchbracket pivotably supported in the housing, the clutch bracketconfigured to approximate and separate the crown of gear teeth of theclutch gear with the crown of teeth of the drive screw; a drive shafthaving a first portion and a second portion, the first portion of thedrive shaft extending through the clutch gear and being rotatablysupported in the drive screw; and a trigger operatively connected to thedrive assembly and selectively engageable with the clutch bracket tospace apart the crown of gear teeth of the clutch gear with the crown ofteeth of the drive screw.
 2. The apparatus according to claim 1, furthercomprising: an articulation assembly supported in the housing, thearticulation assembly including: an articulation screw threadablycoupled to the second portion of the drive shaft; and an articulationdial rotatably supported in the housing and coupled to the articulationscrew; and a shaft assembly extending from the housing, the shaftassembly including an articulating neck assembly operatively coupled tothe articulation dial such that actuation of the articulation dialresults in omnidirectional articulation of the articulating neckassembly, wherein when the trigger is in a first position, the triggerengages the clutch bracket to space apart the crown of gear teeth of theclutch gear and the crown of teeth of the drive screw such thatactuation of the articulation assembly does not actuate the driveassembly.
 3. The apparatus according to claim 2, wherein the housingincludes a pair of articulation actuators translatably supported thereinand the articulation screw defines a pair of oppositely oriented groovesformed in a surface thereof, wherein each articulation actuator isengaged with a respective groove of the articulation screw, wherein aproximal end of an articulation cable is secured to a respectivearticulation actuator such that rotation of the articulation dialresults in rotation of the articulation screw, and opposed translationof the articulation actuators, to omnidirectionally articulate thearticulating neck.
 4. The apparatus according to claim 2, wherein theshaft assembly includes an end effector assembly supported on a distalend of the articulation assembly, the end effector assembly configuredto form a surgical clip.
 5. The apparatus according to claim 4, whereinwhen the trigger is in a second position, the trigger disengages fromthe clutch bracket such that the crown of gear teeth of the clutch gearengages the crown of teeth of the drive screw of the drive assembly. 6.The apparatus according to claim 5, wherein when the crown of gear teethof the clutch gear engages the crown of teeth of the drive screw of thedrive assembly, rotation of the drive screw of the drive assemblyresults in rotation of the drive shaft, such that rotation of the driveshaft rotates a drive screw of the end effector assembly to form thesurgical clip.
 7. The apparatus according to claim 2, wherein the shaftassembly is rotatable about a longitudinal axis with respect to thehousing.
 8. The apparatus according to claim 2, wherein the articulatingneck assembly includes a plurality of inter-connected articulationjoints.